Provider Demographics
NPI:1336693993
Name:RIVERSIDE RADIOLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:RIVERSIDE RADIOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASSEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-781-2273
Mailing Address - Street 1:PO BOX 511412
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7967
Mailing Address - Country:US
Mailing Address - Phone:877-441-9002
Mailing Address - Fax:559-455-4016
Practice Address - Street 1:3309 SQUIRREL RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48304-2456
Practice Address - Country:US
Practice Address - Phone:248-644-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty